Coming of Age During an Epidemic: Are Our Children Prepared to Protect Themselves?

To end the HIV/AIDS epidemic, the National HIV/AIDS Strategy (NHAS) describes the need for evidence-based prevention programs, particularly for Black youths, who are coming of age in the midst of an epidemic among their peers. Yet students return this fall to schools that have few concrete goals in place to improve or even standardize sexual- and reproductive-health education, whose content and accuracy varies by geographical region, by school district and even from classroom to classroom--and is widely viewed by experts as a mess.

"The federal government can only do so much," says Greg Millett, senior policy adviser in the White House Office of National AIDS Policy (ONAP). "An awful lot of control resides at local school boards regarding what can and can't take place in curricula."

So although the National HIV/AIDS Strategy claims a "coordinated plan," some school districts still offer comprehensive sexuality education (pdf) (also called abstinence-plus), and other classes teach only abstinence (called abstinence-only ). Abstinence-plus includes information about refraining from sex until marriage while providing medically accurate instruction about preventing pregnancy and sexually transmitted diseases (STDs).

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Unlike its approach to other federal agencies, the NHAS does not task the Department of Education with meeting any benchmarks. All of the sex-education objectives were punted to the Centers for Disease Control and Prevention (CDC), which the NHAS has charged with ensuring that "school-based health education is providing scientifically sound information about HIV transmission and risk-reduction strategies." The CDC interprets this mandate to mean providing funding and technical assistance to HIV-prevention programs, as well as guidelines and resources to school districts, according to a CDC spokesperson.

In 2009 when President Barack Obama took office, he redirected dollars into evidence-based programs--those with research to scientifically prove their results. Most abstinence-only plans lack credible evidence that they work (although some that are focused on young adolescents but without the moralizing characteristic of most abstinence programs have proved effective).

This year, however, $50 million annually for abstinence-only education was slipped into health-care reform. States can apply for federal funding for either type of program or both; however, there seems to be a shift toward prevention that works. Forty-three states applied for the Personal Responsibility Education Program (PREP), teaching comprehensive sex education. Twenty-seven states applied for the abstinence-only dollars.

"States are absolutely leading the way" in the transition, says Jen Heitel Yakush, public policy director for the Sexuality Information and Education Council of the United States (SIECUS). As an example, Yakush cites Washington, D.C., which vastly improved its sex education after HIV rates among its Black youths became impossible to ignore.

"Our message to other states is, 'Don't let your HIV rate get as bad as the District's before you implement comprehensive sex ed in schools,' " she says.

Sex Ed Replacing Sex After School?

In the meantime, many Black youths and their families have begun looking outside the classroom for good-quality sexual-health education.

"A lot of the sex education doesn't break through the noise. It doesn't deal with problems like, 'How do I deal with the trauma of being raped?' or 'I'm ugly and no one likes me,' " says Cleo Manago, whose work as founder of the African American Advocacy, Support-Services & Survival Institute (AmASSI) Center--a Los Angeles-based community health, wellness and cultural-affirmation center--leads him to regularly counsel young Black people.

To fill in the gaps left by Atlanta public schools, some parents bring their children to sex-education workshops offered at SisterLove, an HIV-prevention and reproductive-health nonprofit organization, says founder Dazon Dixon Diallo.

"We haven't seen a lot of policy change, especially across the South," Diallo says. "We haven't seen schools rework sexual-education curriculum. But from the field itself, we've seen an emboldening among educators and young people."

Diallo believes that lowering HIV rates requires "cradle to grave" sex education and "normalizing sexual health so it's mainstream and common in conversation."

Unfortunately, that doesn't exist thus far. Jackie Brooks, 17, says that her Chicago public school didn't offer sex ed until she was in the ninth grade, an age by which many Black teens are sexually active. Even then, her teacher taught students how to avoid pregnancy and STDs transmitted through heterosexual sex but not by way of "different relationships," she says.

Now a peer educator for Illinois Caucus for Adolescent Health, Brooks sees the fallout in her community from the inadequate knowledge about sexual health, recalling a female friend who came to her scared because her boyfriend had removed the condom during sex.

"Young people need to know what options are available to them," Brooks says. "Families are afraid to talk about it. Teachers are afraid to talk about sex."

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